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Expected discouragement has set in after getting my CAC score update.
Everything I could think of in my power to shunt my last CAC test in the opposite direction has apparently failed when I saw that my score has essentially tripled in the last three years.
Something has gone askew, against what I had mapped out, against every conceivable supplement, dietary intervention and exercise routine I could think of.
What the hell is left? More aggressive fasting? CR? Done all THIS and more.

Wheat, gluten, soy, yeast, sugar, trans fat, seed oil free, organic, grassfed, LCHF pastured, whole foods diet.
In 2014, my score was ZERO. In 2018, 9.03 in the LAD (widowmaker artery) – the warning light started!
Latest: 25 in the LAD (sh*t!) and 3 in the RCA
What could possibly be left that I’m doing WRONG to warrant further plaque progression?
Genetically cursed with those SNPs I mentioned?
Still unoptimized thyroid function? Elevated TSH with normal FT3, FT4, TPO, TgAb.
Taking 90mg NP Thyroid despite the recent recalls as I didn’t think the 10-15% drop in potency would have made that much difference. Maybe I was wrong?
– dose change?
– switch to compounded NDT?
– switch to pure T4 (Tirosint)?
– better off not changing; not going to make a difference? T4 meds definitely not going to help reduce lipids?
Gut issues?
Fasting glucose? Latest OGTT w/ fasting insulin was pretty good, showed robust insulin response. Last a1c: 5.1
Excess adiposity?
Inflammation? hsCRP has never been <1.5 for last 20 years; nothing I've tried to date has ever reduced that.
Hi-dose delayed-release niacin (Endur-acin) – raise liver enzymes
Lipid markers would be the first place I'd look and that's where the problems are:
Off the top:
– Pattern B
– sdLDL-P
– Lp(a)
-Trigs
Low normal HDL
If sdLDL-P is a main trigger and then maybe look at PCSK9 inhibitors as an alternative to statins?
Until I discover what the driving force in my case is, how will I know what path to reverse it to focus on?
 
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Are you currently on statins and your score still got worse? What does your trt protocol look like? How long have you been on it.
 
Should I be surprised that at some point, someone with some insight will take me right back to the journey I already started. Thanks.
 
Read up on vitamin K2. Two forms; Mk4 and Mk7. K2 shunts calcium to the bones and teeth while keeping it out of the arteries and brain. That's the very basic. It actually acts more like a hormone, similar to vitamin D.
 
Heart scan of 25, is super low. Anything below 100, is reversible. I would find a good lipidologist, that will lead you down the right path and will do the proper labs.
 
Read up on vitamin K2. Two forms; Mk4 and Mk7. K2 shunts calcium to the bones and teeth while keeping it out of the arteries and brain. That's the very basic. It actually acts more like a hormone, similar to vitamin D.
Thanks but have already been taking plenty of K2 for some time now.
 
Heart scan of 25, is super low. Anything below 100, is reversible. I would find a good lipidologist, that will lead you down the right path and will do the proper labs.
There's only one lipidologist I know of, outside of my area, need to check again if she does telemedicine.
 
What is your fasting insulin? "robust insulin response" is not necessarily good if that is what is holding your blood sugar down and it is chronically elevated. Here are some other ideas...

 
What is your fasting insulin? "robust insulin response" is not necessarily good if that is what is holding your blood sugar down and it is chronically elevated. Here are some other ideas...

It was a comment the endo made. My fasting insulin usually hovers around 4-5. I attached my OGTT w/ insulin (trying to duplicate the Kraft test).
 

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Heart scan of 25, is super low. Anything below 100, is reversible. I would find a good lipidologist, that will lead you down the right path and will do the proper labs.
Most of the reports I've gleaned of plaque reversal were anecdotal and none that showed reversal <100. If you have any links to actual papers, would greatly appreciate.
 

In my opinion, we really don't know much about how atherosclerosis is reversed, because it is very rare for it to happen. Most people don't have a lessening of calcium score happen, and if they do, it's usually a small and frequently reversed lessening. It's possible that some reversals happen in a negative way, for example it could be that a thin cap atheroma forms as as a consequence of regression of plaque or of calcium. That has been seen in some studies using VH-IVUS to study a group of patients with atherosclerosis, and then repeating the study on these patients one year later. This allowed them to see how plaque changed from one year to the next. They divided the initial situation into 5 different manifestations of plaque, which they labeled as PIT (Pathological Intimal Thickening), TCFA (Thin Cap Fiberatheroma), Thick-Capped Fiberatheroma, Fibrotic Plaque, and Fibrocalcific Plaque. They found that after a year, many of the plaques had changed from one type to another, showing just how malleable plaque can be.
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The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization, by Kubo et el.

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Consider SIBO/SIFO, as the endotoxemia of these conditions are drivers of atherosclerosis.

SIBO And SIFO: Finding The Best Treatment | Dr. Satish Rao (learntruehealth.com)
In regards to dysbiotic flora, TMAO comes back up as another atherogenic concern [Gut microbiota in atherosclerosis: focus on trimethylamine N‐oxide], especially for those of us supplementing with either choline (to reduce NAFLD, for one) or L-carnitine (fatty acid synthesis, mitochondrial support, CV health), thus, both could be double-edged swords when they hit the gut and dysbiotic bacteria go to work. Only thing I can think to bypass GI would be injectable forms of these compounds [Injectable Choline for Cognitive Performance and Health]. I've measured serum TMAO before and my results varied, sometimes within range and one time elevated. Not too many docs have a knowledge base on this.
Resveratrol, probiotics, olive oil seem to help reduce levels. Similar newer finding of another anti-TMAO compound: Effects of Grape Pomace Polyphenolic Extract (Taurisolo®) in Reducing TMAO Serum Levels in Humans: Preliminary Results from a Randomized, Placebo-Controlled, Cross-Over Study
 
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If you can check your visceral fat level and body fat/muscle ratio thru DEXA scan, it may help from there....all this inflammation that comes from belly fat needs to be addressed, I myself did all the instruction plus a low dosage of rosuva.
 
If you can check your visceral fat level and body fat/muscle ratio thru DEXA scan, it may help from there....all this inflammation that comes from belly fat needs to be addressed, I myself did all the instruction plus a low dosage of rosuva.
No doubt this is a contributing factor. Adipokines. Would rather try Nextletol or an antisense drug than a statin, but that'll be an in-depth discussion with a cardio or lipid doc.
 
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I was able to reduce 80lbs of weight in 2017, all inflammation marker went down significantly. Added little bit of rosuva and these LDL-C almost goes to zero haha, first time in my life I can make HDL > LDL-C (weightlifting only increases HDL level by 25%)... I believe there's huge correlation between inflammation/calcification and testosterone level, lot of feedback loops. My issue 10 years ago was very low T that causes inflammation and belly fat, not including bad carbs diet. I switched to TRT few months ago and I can't believe all the numbers are even better. I'm constantly watching my hematocrit btw.
 
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